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Three Secrets to Take Control of an
Unruly Order Set Catalog
Session 136, February 13, 2019
Paula Scariati, DO, MPH, MS
Medical Director Health Informatics, Dignity Health
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Paula Scariati, DO, MPH, MS has no real or
apparent conflicts of interest to report.
Conflict of Interest
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The Problem
Order sets Versus Protocols
The Three As
Lessons Learned
Next Steps
Agenda
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Why Am I Here?
What Do I Stand
For?
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List the key data that should be tracked as part of
Evidence-based Knowledge Governance (EKG)
Define the process for assigning a clinical home to an
electronic order set
Identify strategies that make Evidence-based
Knowledge Governance (EKG) physician friendly
Learning Objectives
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Why Am I Here?
What Do I Stand
For?
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Dignity Health
5
th
largest nonprofit health
system in the U.S.
22-state network of 9,000
physicians
More than 400 care centers
62,000 employees
Provides more than $2.2
billion in community benefit
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The Problem
Lack of visibility into order sets that need
updating
Undefined oversight
Lack of centralized governance
Understaffed order set teams
Lack of build standards
Single source of truth
Versioning control
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The Scope
First EHR go live 10+ years ago
Acute + Ambulatory
Over 1200 order sets
2 domains
8 regions
Discontinued using order set management
software in 2013
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What type of facility do you work in?
1. Critical Access Hospital
2. Community Hospital
3. Academic Hospital
4. Clinic
Question 1
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How many order sets are in your EHR catalog?
1. <250
2. 250-499
3. 500 749
4. 750 or more
Question 2
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Question 3
Do you use separate software to manage your order sets?
1. Yes
2. No
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Why Am I Here?
What Do I Stand
For?
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Order Set
Menu Order
Set
Enterprise
Group
Enterprise
Evidence
Review
Protocol
Order Set
Local
P&T
P&T
Evidence
Review
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Order Set
Menu Order
Set
Enterprise
Group
Enterprise
Evidence
Review
Protocol
Orderset
Local
P&T
P&T
Evidence
Review
Evidence-based order set that offers
a menu of choices to physician
If new evidence is published, order
set knowledge is updated via
specialty-specific decision body
No CMS regulations on how often
these should be reviewed
On-demand & if age > 3 years
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Order Set
Menu Order
Set
Enterprise
Decision
Body
Enterprise
Evidence
Review
Protocol
Order Set
Local
P&T
P&T
Evidence
Review
On-Demand
or
Age > 3 yrs
Annual
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Three Secrets
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Automate the
Data
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Demo
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Assign Order Sets
a Home
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Assure a Physician
Friendly Process
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People
Process
Platform
Physicians
Nursing
Clinical Informaticist
Pharmacy Informaticist
Quality
System PT
Physician Informaticist
EHR Builders
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EKG Review
Is a Team Sport
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Process
Before Meeting
Decision body core team reviews their EKG report during the
prep meeting
EKG placed as discussion item on decision body agenda
led by facilitator or chair
During Meeting
Decision body members determine order set to review
One regional physician and regional clinical informaticist
(volunteered /voluntold) to perform a first-level (initial) review
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Guidelines for Annotating
Please place order sentences under the correct
heading and maintain the standard heading
order observed for all Dignity Health
PowerPlans:
ADT/Consents
Vital Signs
Activity
Patient Care
Respiratory
Diet
IV Solutions
Medications
Laboratory
Diagnostic Tests (Radiology)
Consults
Please place order sentences under the correct
heading and maintain the standard heading
order observed for all Dignity Health
PowerPlans:
ADT/Consents
Vital Signs
Activity
Patient Care
Respiratory
Diet
IV Solutions
Medications
Laboratory
Diagnostic Tests (Radiology)
Consults
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Lead with the data assigning an order set a home can be tricky
Have guidelines for defining best practice
NCCN for Oncology regimens
Make nursing and pharmacy an integral part of the review process
Communication orders
Protocols
Formulary standardization
Antimicrobial Stewardship
Don’t let the perfect be the enemy of the good
Work with build team to track date last reviewed
Set expectations on TAT and throughput
Lessons Learned
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C-suite sponsor
Core team socialization
Assign each order set a home
Create tracking mechanism
Pilot with one or two specialty groups to refine the process for
your organization
Next Steps
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Glenda Colahan Project Manager
Cassandra Baqir IT Technical Analyst
Stuart Gray Clinical Applications Analyst
Missie Altree Enterprise Clinical Informaticist
Yvette Kirk Pharmacy Optimization
Steve Hori Pharmacy Optimization
The EKG Team
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Questions
Paula Scariati, DO, MPH, MS
Medical Director Health Informatics
Dignity Health
Paula.Scariati@DignityHealth.org
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